Published by Sean on 15 Feb 2008 at 12:54 pm
Family-Centred Care?
I walked through my front door at 20:15 last night feeling beaten and broken. My brain felt like it had been placed in a blender on high–simple thoughts felt like complex calculus equations.
It wasn’t a bad week, per say. It was simply busy beyond belief. And it wasn’t really a fun busy in which I was floating from one fascinating challenge to another. No, it was just wall-to-wall basic simple tasks.
Wednesday, setting a personal record, I had medications due every hour for 12 hours straight. Who has time for the “art of nursing” when all you do is dispense medications? Often, there were so many meds due that no sooner had I just finished one hour’s meds when it was time to start the next hour’s. I remember sitting there in one patient’s room looking at a line-up of six IV piggy backs, wondering how I would get them all in before the next hour’s collection. You know you need more access when…..
Everyone had sliding-scale insulin every four or six hours. I felt like I was running a diabetes unit! They all had multiple drain dressings. They all needed TPN prepared and hung at 17:00. And, of course, they all needed to go for x-rays, CT scans, rehabilitation etc.
All of them were upset because the doctors kept telling them they would do one thing, and then they would either forget to put in the orders, or do something completely different.
The patients were all needy, anxious, demanding, and came with family that were even more needy, anxious, and demanding. My favorite family member was a physician who practices in a completely different area of medicine–not a surgeon, and not even the same part of the body–and he’s from a different city. However, this certainly didn’t stop him from trying to give me verbal orders. At one point he even started paging department heads to come and consult on “his” patient.
My other favorite family member of the week was a wife of another patient. She stopped me as I was almost running down the hallway. Here’s an exact-ish quote of what she said: “My husband seems a little drowsy since you increased his fentanyl dose. Could you weigh him and perhaps calculate the half-life of the fentanyl for me. And his blood pressure was 120/75 last time–which is still worrying me since it is usually in the 130s systolic.”
In one hand I had a non-rebreather, and in the other hand I grasped several vials of ventolin. I wore a calm, yet sufficiently panicked look on my face. My other patient was gasping for air in respiratory distress.
“I’m sorry, I can’t right now, I have an emergency!” I said as I tried to get around her. She had blocked me in. “I’ll be there when I have time.”
She mumbled something about nursing care and incompetent and stomped toward the front desk. I presumed she was looking for the charge nurse who was actually with me helping the distressed patient.
*sigh*
Family-centred nursing just isn’t appropriate all the time, and it certainly doesn’t always work.





shrimplate on 15 Feb 2008 at 1:31 pm #
Head Nurse had a recent post in which she describes how when patients and family members try to guide care, what they get is less than best, because they pretty much don’t know what the fuck they’re talking about.
Sean on 15 Feb 2008 at 2:10 pm #
harsh, but very well said
Prisca on 15 Feb 2008 at 3:42 pm #
UGH-patients just dont get it–they really dont know, do they??? (((HUGS)))
Deb on 15 Feb 2008 at 11:25 pm #
Your blog makes me appreciate my husband’s RN work for the past 25 yrs. It’s an eye opener to hear from a male nurse. Keep writing. It’s good therapy. I always said I wanted to go into nursing but all these years he’s told me it’s the worst profession to be in. I can see why. Instead, I deal with the public about their credit cards. Now that;s a fulfilling career. NOT!
Sean on 16 Feb 2008 at 6:50 am #
It is the worst, but it’s also the BEST! Don’t forget all the good
things I’ve said about nursing in my blog!!!
Vanda on 16 Feb 2008 at 7:21 am #
As a non medical person I just do not understand family members like that. When my hubby was in hospital I did ask the nurse if I had a question but would never ever suggest treatment. Stupid, stupid people. And I asked if there was anything they were doing that I could do, that makes sense to me.
Sean on 16 Feb 2008 at 8:29 am #
Vanda, you sound like the type of person family-centered nursing DOES work for. When a family physically becomes involved with hands on care, it truly makes a difference in a patient’s outcome–please don’t ask for references, but I know they’re out there! Families are great for helping with daily care such as washing, brushing teeth etc. No, it’s NOT necessarily a family’s job…however, if they want to be involved, that’s their chance! Family-centered care doesn’t mean that your doctor friend from out of town gets to order a different pain control regime! LOL
RehabRN on 17 Feb 2008 at 6:29 am #
Sean:
I had the same lady you did! She actually interrupted my report in order for her husband to get his Fentanyl patch. Not that his patch was due right this second, not that he didn’t have PRN pain meds on board, nope, she just wanted it right then and my coworker just wanted to get her the hell away from us, so she smacked it on and took off the old one.
This same lady, later this week, decided to quiz the docs on why hubby was now getting IV antibiotics again. I had explained to her that it was most likely prophylactic (as the doc told me), but she just went ape. I paged the doc and told her of the wife’s distress. (Meanwhile, the pt was wonderful and understanding–wife was an ogre!) I had two specialists in the room with her, so I let them deal with her.
They wrote so many orders (and continued every time I tried to get the secretary to enter them) that I could not even sign them off before I handed him off to another coworker.
My favorite order: pt to have rectal temps q4hrs. I managed to convince the doc to go to BID and found him a rectal one in our closet, so no one would get mixed up.
Needless to say, I was thrilled to death to get out of there on Friday!